Principles and indications for primary venous repair

The management of injured veins continues to represent a formidable and stimulating challenge. While there has been past resistance to repair injured veins, and the controversy persists for some, an increasing number of reports emphasize that a more aggressive approach to the repair of injured veins is warranted, particularly in the lower extremities. The recent experience in Southeast Asia, as outlined in reports from the Vietnam Vascular Registry, has demonstrated that some of the previous fears of an increased incidence of thrombophlebitis or pulmonary embolism with attempted venous repairs are unfounded. The long-term follow-up of 10 years' duration or longer of 110 patients with isolated popliteal venous injuries documents significant edema in 51% of patients who had ligation of injured veins, in contrast to only 13% of those who had attempted venous repair. Recent civilian experience is similar to the military experience in Vietnam. Venous reconstruction remains one of the challenges in surgery in which additional development can be anticipated, in late reconstruction as well as the initial management of injured veins.